Quick Response to Stroke Symptoms Must Trump COVID-19 Anxiety

May 13, 2020

May is Stroke Awareness Month

As a vascular neurologist, I’m concerned that people’s fear of catching COVID-19 is stopping them from seeking health care, even those who may be gravely ill. Having a stroke is a major emergency that requires immediate medical intervention, yet people with symptoms erroneously believe the risk of coronavirus infection is a greater threat.

I assure you it is not.

Anyone who experiences symptoms of stroke must not test time. When you have a stroke, every minute that passes without treatment costs your brain millions of neurons. Stroke is the fifth leading cause of death in the U.S. Survivors can face lifelong disabilities. Quick intervention saves lives and can minimize — and in some cases reverse — serious damage to the brain and nervous system.

Atlantic Health System’s five state-designated stroke centers are taking extraordinary precautions to minimize the risk of coronavirus exposure while continuing to provide swift treatment for each patient’s best outcome. We revamped emergency department protocol so that patients who arrive with suspected stroke will have most, if not all, of their diagnostic evaluation and emergency treatment handled in one location. Let me walk you through a scenario:

A person experiences one or more of the tell-tale signs of stroke, expressed in the acronym, BE FAST:

B stands for trouble with balance;
E for eyes and vision problems;
F for facial droopiness;
A for arm (or leg) weakness;
S for speech problems; and
T is for time.

If a person experiences any of the symptoms or sees another person experiencing them, call 911 immediately.

Getting to the hospital by ambulance is best because first responders know the location of the closest Joint Commission and New Jersey-designated stroke centers and will relay vital signs and other key patient information to the medical staff ahead of arrival.

The patient is greeted by emergency department staff in full protective gear (N-95 masks, gloves and gown) and the patient is given a mask and tested for COVID-19. The patient is brought directly to a room for a CT-scan. A vascular neurologist not in the ED uses a telestroke robot to review the CT-scan results, ask questions of the patient, and conduct a remote examination with assistance from an ED nurse. The neurologist could also use the telestroke robot to talk to the patient’s family member.

The neurologist determines if a stroke occurred and, if so, whether it was ischemic, meaning caused by a blood clot that is blocking blood supply to the brain, or hemorrhagic, the rupturing of a blood vessel that causes bleeding in the brain.

Patients who would benefit from tPA, the clot busting medication that can reverse damage caused by ischemic stroke, would receive it in the room. Others may have a clot surgically removed. Patients who experienced a hemorrhagic stroke would be administered medications to reduce blood pressure and slow bleeding.

Only when the patient is stabilized would he or she be moved to a hospital room, and the treatment space then sanitized. We call this process ‘bundling care.’ It further reduces the patient’s and staff’s potential exposure to the coronavirus.

I’ve treated people who had no risk factors for stroke, yet suffered major strokes. At the hospital, they tested positive for COVID-19, despite having been asymptomatic to that point. Based on observation and reported case reports, it is believed that the virus causes a coagulopathy, a blood disorder that can cause excessive clotting or bleeding, in some people. How coagulopathy develops with COVID-19 is not yet fully understood, but immediate treatment is crucial for survival.

The bottom line is this: if you or a family member experience any of the BE FAST symptoms, call 911 immediately. It truly could be the difference between life and death.